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Cited by 152Posttraumatic Stress Disorder ResearchStress Responses and CortisolChild Abuse and Trauma

Posttraumatic stress disorder: A metabolic disorder in disguise?

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Michopoulos, Vasiliki, Vester, Aimee, Neigh, Gretchen·2016·Experimental Neurology
DOI 10.1016/j.expneurol.2016.05.038PMC PMC5056806
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Abstract

Posttraumatic stress disorder (PTSD) is a heterogeneous psychiatric disorder that affects individuals exposed to trauma and is highly co-morbid with other adverse health outcomes, including cardiovascular disease and obesity. The unique pathophysiological feature of PTSD is the inability to inhibit fear responses, such that individuals suffering from PTSD re-experience traumatic memories and are unable to control psychophysiological responses to trauma-associated stimuli. However, underlying alterations in sympathetic nervous system activity, neuroendocrine systems, and metabolism associated with PTSD are similar to those present in traditional metabolic disorders, such as obesity and diabetes. The current review highlights existing clinical, translational, and preclinical data that support the notion that underneath the primary indication of impaired fear inhibition, PTSD is itself also a metabolic disorder and proposes altered function of inflammatory responses as a common underlying mechanism. The therapeutic implications of treating PTSD as a whole-body condition are significant, as targeting any underlying biological system whose activity is altered in both PTSD and metabolic disorders, (i.e. HPA axis, sympathetic nervous systems, inflammation) may elicit symptomatic relief in individuals suffering from these whole-body adverse outcomes.

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  • Chronic conditions such as coronary artery disease, fibromyalgia, rheumatoid arthritis, Major Depressive Disorder, and Post Traumatic Stress Disorder are associated with abnormally high cortisol levels and metabolic disruptions.

    “chronic conditions such as coronary artery disease, fibromyalgia, rheumatoid arthritis, and mood disorders such as Major Depressive Disorder (MDD) and Post Traumatic Stress Disorder (PTSD) have also been associated with abnormally high CORT levels and metabolic disruptions ( 5-13 ).”

    From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [6]

    The HPA Axis and Metabolic Alterations in PTSD section (page unavailable) links PTSD to metabolic alterations, but says baseline cortisol does not consistently differ in PTSD and cortisol response to acute stress is decreased. It associates elevated cortisol with metabolic syndrome, not PTSD. The cited passages do not establish the claim for coronary artery disease, fibromyalgia, rheumatoid arthritis, or major depressive disorder. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Many conditions associated with hypercortisolism are accompanied by disruption of normal glucose metabolism while preserving some degree of cortisol rhythmicity.

    “many of these conditions are accompanied by a disruption of normal glucose metabolism while preserving some degree of CORT rhythmicity.”

    From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [6]

    In “The HPA Axis and Metabolic Alterations in PTSD” (page unavailable), the review associates increased basal cortisol tone in metabolic disorders with insulin resistance and glucose intolerance. It does not say whether cortisol rhythmicity is preserved in those conditions; searches for rhythm, circadian, and diurnal did not establish that part of the claim. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • In hypercortisolism, cortisol levels are higher than normal and in some cases display abnormal rhythmicity, varying by underlying condition.

    “in hypercortisolism, it is not only that CORT levels are higher than normal, but in some cases, they also display abnormal rhythmicity. This varies depending on whether the underlying condition is associated with Cushing's syndrome, depression, PTSD, acute inflammation following major surgery, or chronic inflammatory diseases (e.g., rheumatoid arthritis) ( 2, 5-13, 57-60 ).”

    From Dynamic modulation of glucose utilisation by glucocorticoid rhythms in health and disease (2020) · cites this paper as [6]

    The HPA Axis and Metabolic Alterations in PTSD section (page unavailable) reports heightened morning cortisol in obesity and metabolic disorders, supporting elevated cortisol in some conditions. It says baseline cortisol does not consistently differ in PTSD and does not describe abnormal cortisol rhythmicity or how rhythmicity varies across the listed conditions. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Michopoulos, V., Vester, A., & Neigh, G.
Affiliations
Emory University (US)
Corresponding author
Neigh, Gretchen
ORCID
Venue
Experimental Neurology
Publisher
Elsevier BV
Published
2016-10
Volume
284
Issue
Pt B
Pages
220-229
ISSN
0014-4886 (ISSN-L)
DOI
10.1016/j.expneurol.2016.05.038
PMC
PMC5056806
OpenAlex
W2412281345
Cited by
152
References
42
Citations by year
2026: 12 · 2025: 26 · 2024: 30 · 2023: 15 · 2022: 18 · 2021: 16 · 2020: 11 · 2019: 12 · 2018: 9 · 2017: 3
FWCI
1.18
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Experimental Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (P51OD011132)
  • National Institute on Aging (U54AG062334)
  • National Institute of Mental Health (R01MH110364, K18MH105098)
  • National Institute of General Medical Sciences (T32GM008169)
  • National Institute of Allergy and Infectious Diseases (R38AI140299)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD085850)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords
post-traumatic stress disorder, metabolic disorders, obesity, cardiovascular disease, diabetes mellitus, fear inhibition, sympathetic nervous system, hypothalamic-pituitary-adrenal axis, neuroendocrine dysfunction, inflammation, comorbidities
MeSH terms
Fear, Humans, Hypothalamo-Hypophyseal System, Inflammation, Pituitary-Adrenal System, Stress Disorders, Post-Traumatic

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